血清IL⁃9水平对急性脑梗死患者早期神经功能恶化的预测价值

目的：探讨血清白介素（interleukin，IL）-9 水平在急性脑梗死早期神经功能恶化（early neurological deterioration， END）患者血清中的变化并评估其对END的预测价值。方法：收集106例脑梗死患者，根据是否发生END，将患者分为END组 42例，非END组64例，收集患者的一般资料，并记录入院时美国国立卫生院神经功能缺损（National Institute of Health stroke scale，NIHSS）评分，检测血清生化指标、基线期血清IL-9、C反应蛋白（C-reactive protein，CRP）和IL-6水平。相关性的评估采用Pearson或Spearman相关性分析，采用Logistic回归分析脑梗死患者发生END的影响因素，并绘制受试者工作特征（receiver operating characteristic，ROC）曲线评估血清IL-9水平在脑梗死后发生END中的预测价值。结果：END组糖尿病比例、颈动脉狭窄＞50%比例、低密度脂蛋白胆固醇、糖化血红蛋白、脑梗死体积和入院时NIHSS评分均高于非END组（P ＜ 0.05）。END组血清 IL-9水平明显高于非END组（P ＜ 0.01）。脑梗死患者血清IL-9水平与入院时NIHSS评分呈正相关（r=0.535，P ＜ 0.01）。 Logistic回归显示血清IL-9水平、颈动脉狭窄 ＞ 50%、脑梗死体积和入院时NIHSS评分为END发生的危险因素（P ＜ 0.01）。血清 IL-9 水平预测 END 发生的 ROC 曲线下面积为 0.815。血清 IL-9 水平与血清 CRP 水平（r=0.648，P ＜ 0.01）和 IL-6 水平 （r=0.765，P ＜ 0.01）均呈正相关。结论：血清IL-9水平在脑梗死END患者中明显升高，对END的发生具有良好的预测作用。     

静脉溶栓治疗后不明原因早期神经功能恶化相关因素和临床特征分析

目的 探讨急性缺血性脑卒中（AIS）患者行静脉溶栓治疗后不明原因早期神经功能恶化（END）的相关因素及临床特征。方法 纳入2016年1月至2018年2月于我院脑血管病中心连续登记的发病4.5 h内接受单纯重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗的AIS患者。不明原因END定义为发病24 h内美国国立卫生研究院卒中量表（NIHSS）评分较基线增加≥4分,且影像学检查未发现确切机制。比较不明原因END与无END AIS患者的一般资料和治疗前临床数据,同时分析不明原因END AIS患者的临床特征。结果 纳入患者258例,其中无END患者243例（94.2%）,不明原因END患者15例（5.8%）。相比无END患者,不明原因END患者中糖尿病比例高,入院至静脉溶栓时间（DNT）长,差异均有统计学意义（χ²=6.093,P=0.048;Z=2.055,P=0.040）。15例不明原因END患者溶栓前NIHSS评分较低[5（4,9）分],急性脑卒中Org 10172治疗试验（TOAST）分型以小动脉闭塞最多（11例,73.3%）,梗死部位以内囊后肢（6例,40.0%）和脑桥腹内侧（6例,40.0%）最多。结论 糖尿病、DNT延长可能是AIS患者静脉溶栓治疗后发生不明原因END的危险因素。不明原因END常见于小动脉闭塞AIS,NIHSS评分较低,梗死部位主要为内囊后肢和脑桥腹内侧。     

血清ADMA、Cav-1水平联合血小板聚集功能检测对急性脑梗死患者END的预测价值

目的：分析非对称性二甲基精氨酸(ADMA)、陷窝蛋白1(Cav-1)水平联合血小板聚集功能(PAgT)对急性脑梗死患者早期神经功能恶化(END)的预测效果。方法：选取我院2019年5月—2022年1月收治的100例急性脑梗死患者为观察对象，参考美国卫生研究院卒中量表(NIHSS)评分分为END组(37例)和非END组(63例)。比较两组入院时一般临床资料及血清ADMA、Cav-1水平、PAgT,并分析发生END的危险因素，各指标不同水平患者发生END危险度分析。结果：与非END组相比，END组入院时血清ADMA、Cav-1水平及PAgT均较高(P<0.05);血清ADMA、Cav-1水平及PAgT与基线NIHSS评分、梗死体积呈正相关(P<0.05);Logistic分析显示，将基线NIHSS评分、梗死体积因素控制后，入院时血清ADMA水平>0.91μmol/L、Cav-1水平>21.81ng/ml、PAgT>69.62%为急性脑梗死患者发生END的独立危险因素(P<0.05);ADMA、Cav-1、PAgT高水平患者发生END危险度较高(P<...     

脂蛋白相关磷脂酶A2与大动脉粥样硬化型脑梗死患者早期神经功能恶化的相关性

目的 探讨脂蛋白相关磷脂酶A2(LP-PLA2)与大动脉粥样硬化(LAA)型脑梗死患者早期神经功能恶化(END)的关系。方法 选取2017年10月至2019年6月于苏州市立医院本部神经内科住院且确诊为LAA型脑梗死的患者,共161例,发病至入院时间均≤48 h。所有患者住院当天行美国国立卫生研究院卒中量表(NIHSS)评分,入院72小时内每天行NIHSS评分。根据患者是否发生END将患者分为END组和非END组,比较两组患者临床资料的差异,将单因素分析有意义的指标纳入多因素logistic回归分析,分析LAA型脑梗死患者发生END的独立危险因素,多因素分析有意义的指标以发生END为金标准,应用受试者工作特征(ROC)曲线分析其对LAA型脑梗死患者发生END的预测价值。结果 与非END组(n=106)相比,END组(n=55)患者糖尿病比例、低密度脂蛋白胆固醇、LP-PLA2、C反应蛋白(CRP)、糖化血红蛋白A1c(HbA1c)、同型半胱氨酸水平均升高,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,LP-PLA2(95%CI:1.008~1.026,P<0.001)、CRP(95%CI:1.110~1.577,P=0.002)、HbA1c(95%CI:1.150~3.274, P=0.013)是LAA型脑梗死患者发生END的危险因素。ROC曲线分析显示,LP-PLA2预测LAA型脑梗死患者发生END的曲线下面积(AUC)为0.703,灵敏度为90.9%,特异度为58.5%;CRP的AUC为0.669,灵敏度为70.9%,特异度为61.3%;HbA1c的AUC为0.638,灵敏度为81.8%,特异度为54.7%。结论 LP-PLA2 是LAA型脑梗死患者发生END的危险因素,且对其有较高的预测价值。     

单核细胞计数/高密度脂蛋白与下肢深静脉血栓的相关性

目的 探讨单核细胞计数/高密度脂蛋白胆固醇（MHR）与下肢深静脉血栓（LEDVT）的相关性及其对血栓形成后综合征（PTS）的预测价值。方法 选取2018年10月至2019年10月于安徽医科大学附属阜阳人民医院住院治疗的LEDVT患者184例为LEDVT组，根据血栓类型分为周围型、混合型和中央型，根据超声评分将其血管损伤程度分为轻度、中度、重度，根据Villalta评分评价是否发生PTS。收集患者临床资料，并计算MHR水平。选取健康体检者52例为对照组。分析MHR与LEDVT的相关性及其对PTS的预测价值。结果 与对照组相比，LEDVT组MHR升高（P<0.05）。MHR在轻、中和重度血管损伤患者中逐渐升高（P<0.05），在周围型、混合型和中央型患者中逐渐升高（P<0.05），与超声评分呈正相关（r=0.882，P<0.05），是LEDVT的危险因素（偏回归系数=6.548，95% CI：5.971~7.125，P<0.05）。MHR临界值为0.325时，预测LEDVT的灵敏度为64.13%，特异度为65.38%，曲线下面积（AUC）为0.754（95% CI：0.688~0.813，P<0.05）；MHR临界值为0.455时，预测PTS的灵敏度为78.00%，特异度为83.08%，AUC为0.838（95% CI：0.770~0.907，P<0.05）。结论 MHR能有效判断LEDVT严重程度，对LEDVT患者是否发生PTS有预测价值。     

阿替普酶静脉溶栓治疗AIS患者短期不良反应观察

目的观察阿替普酶静脉溶栓治疗急性缺血性脑卒中(AIS)患者短期不良反应。 方法回顾性分析本院阿替普酶静脉溶栓治疗AIS患者200例的临床资料。记录患者治疗后临床疗效、治疗前后的美国国立卫生研究院卒中量表(NIHSS)评分以及不良反应发生情况。将未出现不良反应的患者纳入未发生组,出现不良反应的患者纳入发生组。比较两组临床资料,并分析患者出现短期不良反应的影响因素。 结果患者治疗后临床总有效率为90.5%,治疗后7天内不良反应发生率为21.0%。患者治疗后7天NIHSS评分较治疗前明显降低(P＜0.05)。未发生组与发生组患者年龄、高血压史比较,差异有显著性(P＜0.05)。AIS患者出现短期不良反应与年龄、高血压史有关(P＜0.05)。多因素Logistic回归分析结果显示,年龄大、患有高血压是AIS患者发生短期不良反应的危险因素。 结论阿替普酶静脉溶栓治疗AIS,具有较好的临床疗效且患者的不良反应发生率较低。     

轻型缺血性脑卒中后认知障碍及其危险因素分析

目的分析轻型缺血性脑卒中患者发生认知障碍的情况及其危险因素。 方法选取轻型缺血性脑卒中患者198例,随访6～12个月,根据简易精神状态量表(MMSE)分为卒中后认知功能障碍(PSCI)组和卒中后认知正常(PSCN)组,比较两组患者血生化指标以及卒中病灶部位等指标。 结果198例脑卒中患者中,105例患者出现认知功能障碍,PSCI发病率为53.03%。PSCI组患者年龄、空腹血糖、超敏C反应蛋白、NIHSS评分、脑梗死病史发生率以及脑白质疏松发生率均高于PSCN组(P＜0.05)。与PSCN组比较,PSCI组额叶、顶叶、颞叶、枕叶梗死部位患者PSCI发生率更高(P＜0.05)。经Logstic回归分析发现,年龄、脑梗死以及脑梗死部位是PSCI的危险因素(P＜0.05)。 结论轻型缺血性脑卒中后PSCI发生率较高,年龄、脑梗死以及脑梗死部位是其危险因素。     

急性脑梗死患者外周血miR-34c的表达情况及临床意义

目的 探讨急性脑梗死(ACI)患者外周血miR-34c的表达情况及临床意义。方法 选取2020年1月至2021年1月蚌埠医学院第一附属医院神经内科收治的122例,病程72 h内的急性脑梗死患者纳入梗死组;另选取同期在本院体检的无急性脑梗死者40例作为对照组。采用逆转录聚合酶链反应(RT-PCR)检测所有对象血清中miR-34c水平,酶联免疫吸附试验法(ELISA)测定所有对象血清IL-6、TNF-α及CRP水平,同时记录患者入院时的NIHSS评分,根据NIHSS评分将ACI患者分为轻度组46例、中度组50例、重度组26例;采用Pearson法分析脑梗死患者miR-34c与相关炎性因子及病情严重程度之间的关系;绘制受试者工作特征(ROC)曲线,分析miR-34c对ACI的诊断价值。结果 梗死组血清miR-34c表达水平低于对照组,梗死组血清IL-6、TNF-α及CRP水平高于对照组,差异有统计学意义(P<0.05);重度组患者血清miR-34c表达水平低于中、轻度组, IL-6、TNF-α及CRP表达水平重度组高于中、轻度组,差异均有统计学意义(P<0.05);ACI患者血清miR-34c与IL-6、TNF-α及CRP水平均呈负相关(r=-0.392、-0.347、-0.324,P均<0.05);与NIHSS评分呈负相关(r=-0.368,P<0.05);ROC曲线分析显示:miR-34c诊断ACI的AUC为 0.918,灵敏度为 89.015%,特异度为 82.131%,约登指数为0.711,截断值0.868。结论 ACI患者血清中miR-34c表达下调,可作为诊断ACI的血清学标志物,评估神经功能缺损程度,可能与ACI伴随的炎症反应密切相关。     

代谢综合征对急性幕上皮质下腔隙性脑梗死患者短期预后的影响

目的 探讨代谢综合征（MS）对急性幕上皮质下腔隙性脑梗死患者短期认知功能和神经功能的影响。方法 回顾性分析2016年5月—2018年6月潍坊市人民医院神经内科收治的106例急性幕上皮质下腔隙性脑梗死患者的临床资料,根据是否患MS分为MS组46例和非MS组60例,以发病90 d的改良Rankin量表（mRS）评分≥3分为预后不良。所有患者行颅脑MRI检查,比较两组腔隙性梗死灶数量和Fazekas量表评分;比较两组入院及发病90 d的美国国立卫生研究院卒中量表（NIHSS）评分、蒙特利尔认知评估（MoCA）评分和mRS评分;比较两组的血生化指标。采用多因素一般Logistic回归分析短期预后不良的影响因素。结果 MS组患者的腰围、收缩压、舒张压、空腹血糖（FBG）、餐后2 h血糖（2 hPG）、腔隙性梗死灶数量、Fazekas量表评分高于非MS组（P <0.05）,高密度脂蛋白胆固醇（HDL-C）低于非MS组（P <0.05）。MS组患者的入院NIHSS评分、入院mRS评分、发病90 d的NIHSS评分均高于非MS组（P <0.05）,入院MoCA评分和发病90 d的MoCA评分均低于非MS组（P <0.05）,两组发病90 d的mRS评分比较,差异无统计学意义（P >0.05）。多因素一般Logistic回归分析显示MS是急性幕上皮质下腔隙性脑梗死短期预后不良的独立影响因素［O^R=3.695（95% CI：1.288,10.600）］。结论 MS是急性幕上皮质下腔隙性脑梗死短期预后不良的独立影响因素,与脑卒中后神经功能损伤有关,可能与认知功能下降有关。     

降钙素原及T细胞亚群对急性脑梗死后感染的诊断价值研究

目的 研究降钙素原及T细胞亚群对急性脑梗死后感染的诊断价值.方法 选取2015年2月至2016年1月在该院进行诊治的急性脑梗死患者122例,根据患者脑梗死后是否发生感染分为感染组(60例)和未感染组(62例).分别对比两组入院时收缩压、舒张压、体温、美国国立卫生研究所卒中量表(NIHSS)评分,以及脑梗死发生部位,降钙素原、CD4、CD8水平,并进行Logistic回归分析.结果 感染组NIHSS评分为(14.9±5.7)分,明显高于未感染组的(10.6±3.8)分(P＜0.01).感染组脑桥梗死人数占比为35.48％,明显高于未感染组的17.74％ (P＜0.05).感染组降钙素原明显高于未感染组,而CD4、CD8水平则明显低于未感染组(P＜0.05).经多因素Logistic回归分析,影响急性脑梗死后感染的危险因素包括脑桥梗死、NIHSS评分、降钙素原、CD4及CD8水平.结论 临床工作中通过对急性脑梗死患者的降钙素原与T细胞压群进行检查,有利于预测感染的发生.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.